May 28, 2024
Our enhanced dental experience delivers a better standard of care through an expanded provider network of nearly 100,000 unique providers, comprehensive coverage, affordable coinsurance and no out-of-pocket expenses for in-network preventive services. Our medical and dental plans work together to help members live healthier. In fact, members with eligible medical conditions automatically receive additional dental cleanings at no extra cost.
Because good oral health is so critical to overall physical health, integrating medical and dental benefits offers clear advantages. An independent, multiyear Mayo Clinic study of people with multiple medical conditions found medical-dental integration led to improved outcomes and lower inpatient medical costs for employees and employers.
For 2025, we’re enhancing the value of medical-dental integration even further. Beginning Jan. 1, 2025, Asuris dental members with certain medical conditions will be automatically enrolled in Dental4Health, our program that proactively delivers extra preventive oral treatment and care management support. Dental4Health helps improve members’ oral and physical health and lowers their cost of care.
By integrating dental and medical claims, we can identify and automatically enroll members in Dental4Health. We’ll send proactive outreach that’s coordinated through Asuris Care Management, Clinical teams and dental providers to encourage them to use their preventive dental treatments, support them in navigating care options and help them schedule appointments.
Dental4Health preventive treatments are tailored to each member’s medical needs and include two additional dental cleanings or periodontal maintenance visits per plan year, plus additional evidence-based services for certain eligible medical conditions:
- Periodontal scaling: Removal of built-up plaque and tartar from teeth and gums; usually the first line of treatment for gum disease
- Enhanced cleaning to remove excess plaque: Professional cleaning by a hygienist that’s more thorough than brushing and flossing alone
- Oral health screenings with fluoride treatments: Professional assessment of risk for oral cancers, gum disease and tooth health, along with a concentrated dose of fluoride
Medical conditions eligible for the Dental4Health program include chronic obstructive pulmonary disease (COPD); coronary artery disease (CAD); diabetes; end-stage renal disease (ESRD); metabolic syndrome; oral, head and neck cancers; pregnancy; Sjogren’s syndrome; and stroke. Extra dental treatments are shown to improve overall health and reduce medical costs for members. The treatments are valued at up to $1,000 per year, are covered 100% (in-network) with no out-of-pocket member expense or waiting period and don’t count toward members’ annual maximums.
Members receiving a diagnosis of an eligible medical condition, based on claims, will be automatically enrolled in the program and assigned to a care manager.
- Enrollees will receive a Dental4Health welcome letter and regular reminders to utilize their benefits.
- Dentists receive monthly lists of enrollees and proactively contact them to schedule appointments.
- When visiting an in-network dentist for extra preventive services, enrollees don’t pay any out-of-pocket costs, and their annual maximum is not affected.
Dental4Health is available to Asuris Dental members even if they have medical benefits from another carrier. However, because these members’ Dental4Health eligibility must be verified via claims review manually, enrollment in the program is not automatic.
Dental4Health will be embedded in all fully insured commercial Dental plans beginning Jan. 1, 2025. ASO groups can opt in at their renewal or point of sale.
Questions? Please contact your account representative.